Routine inspection·June 20, 2022

On 6/20/22 at 11:41 a.m., Licensing Program Analyst (LPA) Jewel Baptiste conducted an unannounced visit for the purpose of conducting a required annual inspection. On today's visit LPA met with Administrator, Kun “Wendy” Hu who assisted with the visit. The Facility is licensed to served 49 non- ambulatory residents age 60 and above. Facility may retain one bedridden resident in room #11. Hospice wavier approved for five (5) residents. The facility consists of a single level building with resident bedrooms, each having its own bathroom. A library/activity room, chapel, laundry room, facility kitchen and dining room. The facility also has an administration office and medication room and guest restroom. There is a large patio area with sufficient seating and shaded area for resident use. LPA discussed infection control practices with administrator, toured the facility inside and out, reviewed food supply, staff files, and resident medications. Report Continued on 809C Bedrooms have the required furniture including bedframes, dressers, lamps, and chairs. Beds have the required linen and the linen is in good condition. LPA toured the kitchen and observed 7 days of perishables and 2 days nonperishable. Passageways and exits are free of obstruction. Hand sanitizing gel and masks located at the entrance of each room. Bathrooms are cleaned with the required grab bars and no skid matts. LPA observed communal bathroom with no skid matts. Infection control signs posted throughout the facility. The hot water temperature measured at 110.7-119.4 degrees F. The facility temperature at the time of the visit was comfortable. There is sufficient lighting throughout the facility. Medications reviewed and it appears to be given as prescribed. Staff file reviewed to have health screening. During file review LPA observed Staff 1(S1) not associated to the facility. LPA verified with CCL office and staff 1 is cleared but not associated to this facility. LPA found S1 was disassociated to the facility on 5/13/2020. Infection control signs posted throughout the facility and LPA observed 30 days’ supply of PPE’s. Carbon Monoxide and smoke detectors tested in working order. Last disaster drill conducted March 25th, 2022. Administrator certificate # 6000702740 expire 10/10/2023. Pursuant to Title 22 code of regulations, the following deficiencies and civil penalties were cited (refer to LIC 809-D & LIC421 BG): Exit Interview Conducted with Administrator / Appeal Rights Provided / A Copy of the Report Issued.